Does this sound familiar to you? You are eating as healthily as you can. You are counting every calorie. To a point that this is making you miserable. And your weight just does not drop! What is worse, all you need to do is to have that one extra slice of bread or one extra mouthful of rice or that one tiny cheat meal and the few kilos you struggled all month to lose suddenly just piles back on! Some of my patients tell me “I just need to breathe and I gain weight!” Maybe this has happened to you or maybe you know of someone who suffers from this.
Why does this happen? Heard of Homeostasis?
Our bodies loves it when things are stable. In fact, most systems in the body are designed to keep things automatically stable without us even being conscious about it. This is called Homeostasis.
Think about it: your body temperature, your blood pressure, your blood sugar.. are you controlling all these right now? Certainly not consciously but your body is working every second to ensure all these are kept within a very small range. Even things we do not think about like the acidity of your blood, the amount of salt in your serum.. everything is kept in balance. We do not control it and honestly we have very little control over it.
What about weight? For some reason, we have always believed that we are the masters of our own weight. We get to control it with our lifestyles. Unfortunately this is only partially true. Our body is designed to defend a particular weight and this is called the Weight Set Point.
Ever noticed how no matter what you do your body, over time, tends to drift back to a certain weight?
But I do have control over my weight! Really?
This may be partially true. Just like we have some control over our body temperature. You can always sit under the midday sun until your body temperature goes up. But that is untenable in the long run and honestly a very dangerous thing to do. As you spend more time under the sun, your body brings to bear all its mechanisms to keep your body temperature stable. The moment you get into the shade, all these mechanisms immediately work to bring your body temperature back to normal.
Similarly, when you reduce your caloric intake (i.e. diet), your body brings to bear all its mechanisms to maintain your body weight. This includes dropping your resting energy expenditure (previously known as resting metabolic rate). At the same time, your body release hormones that make you feel hungry all the time. This explains why you are constantly hungry (probably miserable), eating like a kitten and still the weight does not drop.
But I have lost weight with diet and exercise before! And my friends too!
Yes of course. Many studies have shown with intensive lifestyle intervention (i.e. diet and exercise preferably under supervision), most if not all people do lose weight. But the very same studies also show that over time (some studies even up to 7 years), everyone eventually puts the weight back on. Maybe not all the weight but most of the weight. In fact in some studies, participants end up heavier than when they first started.
This is because our bodies, with the help of its hormones, are always pulling us back to the Weight Set Point. And have you noticed when you try to lose weight again it is not as easy as before? Perhaps it is because you are slightly older but perhaps it is also because your body, after having suffered one insult, has become even more efficient at defending its weight.
Newsflash! Obesity is a disease!
Both the WHO and US CDC have recognized obesity as a chronic disease. Just like Diabetes.
Just like Diabetes is a disease of sugar dysregulation (the body cannot maintain its blood sugar level at a healthy range), Obesity is a disease of energy dysregulation (the body cannot maintain its energy balance and consequently weight in a healthy range). Both have a genetic component. Both are caused by a complex interplay of hormones.
Both require intensive lifestyle changes to help control it. And if the conditions are mild enough, lifestyle changes may be all the patient needs.
But get this, after a time, both will need medicines to help keep them under control! Although both Obesity and Diabetes share so many common traits, for some reason, we are much more comfortable taking medicines for Diabetes than we are for Obesity. Why is this so? Does not make much sense if you think about it.
It is not about willpower!
Perhaps this is because we still hold on to the now defunct belief that people are obese because they lack willpower. We somehow look down on them and think that they are lazy and all they need to do is to eat a salad and go for a run.
But from my experience, people who suffer from Obesity are one of the most disciplined people around. They eat right, they exercise but at the end of the day, it is an uphill battle to fight against our hormones and our genetics. It is a battle we rarely win.
This is all a scam to sell more drugs!
If you still believe so then please log off and continue with your diet and exercise plan. I sincerely wish you all the best and hope that you lead a long and healthy life.
But please do not allow this scepticism to deny people who are truly suffering from the disease of Obesity the chance to get treatment. There are currently many safe and effective treatments available for various types of Obesity (yes there are types. that is for another time in another article). Medicines popular now include GLP-1 and Contrave.
So what should I do now?
Go see your Doctor and have a frank discussion about your weight.
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